Endocrine Abstracts

JOINT1697

Background: Prolactin-secreting adenomas necessitate careful prenatal management due to their potential for growth during pregnancy. This report presents a challenging case of a 28-year-old woman with a prolactinoma who experienced two closely spaced pregnancies, both of which resulted in cesarean deliveries.

Case Report: A 28-year-old woman first presented to our hospital at the age of 26 years, at 35-36 weeks of gestation, with a 5-year history of a prolactin-secreting adenoma. A pituitary MRI scan in 2018 revealed a microadenoma (6 × 4 mm), which was associated with headaches, elevated prolactin levels, and oligomenorrhea. From 2019, she was initially treated with cabergoline, which resulted in a reduction of prolactin levels (21 ng/ml), tumor regression, and the resumption of normal menstruation. In 2021, conflicting prolactin levels and MRI results were obtained. In March 2021, tumor growth (1.1 × 0.5 × 0.8 mm) and an increased prolactin level (52.5 ng/ml) were observed. However, subsequent testing showed that her prolactin level decreased to 21.7 ng/ml. In September 2023, during her first pregnancy at 35-36 weeks of gestation, she presented with right-sided homonymous hemianopsia on visual field testing. Due to these findings, a cesarean delivery was recommended. A follow-up pituitary MRI scan was scheduled for 6-8 weeks postpartum. However, the patient conceived again just two months after the first cesarean delivery. With informed consent, a pituitary MRI scan without contrast was performed during the second trimester in February 2024, revealing a tumor mass of 7 × 10 mm. She subsequently delivered her second child via cesarean section at 38.5 weeks of gestation. Four weeks postpartum, a pituitary MRI scan with contrast showed tumor regression (3.5 × 3 mm).

Discussion: Pregnancy can induce high mitotic activity of lactotrophic cells in the pituitary, potentially leading to tumor growth in patients with prolactinomas. Enlarged tumor masses can compress surrounding structures, sometimes necessitating cesarean section for delivery. Pregnancy may limit the use of contrast during pituitary MRI scans; therefore, such scans might be required postpartum. Moreover, patients should be advised to wait at least 18-24 months between delivery and subsequent pregnancy to mitigate obstetric risks. Comprehensive prenatal, natal, and postnatal care is crucial for patients with prolactinomas.